Hormone levels begin to decline in both men and women at about age 30, and continue to do so over the years. Decreasing energy, sexual energy, libido, mental acuity, weight gain, loss of muscle tone, and more have all been scientifically associated with the decrease of these hormone levels. At the same time, the risk of serious health conditions such as depression, prostate cancer, diabetes, and heart disease increase. While most Medical Doctors write off these issues as a symptom of “natural aging”, there is usually an underlying reason for the sudden change in physiology, and frequently it is the result of declining hormone levels. Our approach at RenAMI is to modulate these declining hormones for patients with values that prove medical necessity, thus mitigating the negative effects of hormone deficiency by re-establishing a patient’s physiologic health.
If you are reading this, then it is likely that you have discovered this decline in yourself. It just isn’t quite as easy to get up in the morning, or make it into the gym, or do any of a thousand things you took for granted just a few years ago. Even when you do find the motivation to get active, it doesn’t feel like you are getting the results you once did, does it? No matter how hard you push, it doesn’t feel like you are making progress.
If this describes you, then you owe it to yourself to have your hormone levels checked by a professional. If you are deficient, RenAMI can help you recover some of that lost vigor and vitality through our medically administered and supervised Hormone Modulation Therapy program.
The RenAMI Program provides a hormone modulation program that stabilizes and replenishes a patient's declining hormonal levels, providing potential patient’s with a comprehensive medical treatment to restore their physiologic balance. By careful administration of a patient's hormonal therapy we can reverse many of the detrimental effects of hormone deficiency, thus allowing our patients to achieve a stronger and healthier body. Our program has been documented in multiple scientific studies to produce increased muscle mass, decreased body fat, a boost to the immune system, increased skin and bone density, enhanced cognitive function, increased aerobic capacity, and a significant boost to your libido and sexual energy.
Let’s take a look at an anology of an automobile. When you purchase a new car, it has all the various fluids and materials it requires to run properly. However, even if you keep the car in pristine condition, it does require maintenance every few thousand miles or so. Those fluids need to be replaced, and the various parts that experience heavy wear and tear need to be checked. Our bodies are similar in that we start our lives with all the fluids we need, but they deplete themselves as we grow older. By the time we have reached our twenties, most people have achieved peak hormone levels, but those fleeting days of youth pass all too quickly, leaving us with nothing but memories.
Attached to this email is the document “Patient Admission Forms”. Open the document and complete it, then print and sign each page, making certain to initial each page. Instructions for completing the admission forms are listed on the second page of the document.
Once completed, fax forms to RenAMI at (734) 838-0052 with enlarged copies of your insurance card(s), prescription card(s), and a valid state driver’s license or identification card (required for the prescription of controlled substances in most states). Please remember to enlarge the copies of your cards, as faxed copies tend to be grainy and it is vital that our copies are readable.
The last page of the Patient Admission Forms is a credit card agreement for a one time charge for your Initial Evaluation Fee ($250.00, required) and Growth Hormone Evaluation Fee ($250.00, optional). Should you elect to start therapy at the completion of your insurance coverage review and initial consultation, then both of these fees will be deducted from your initial Quarterly Medical Service Fee, which effectively means that your first 3 months of therapy would be free! If you do not elect to pursue Growth Hormone coverage, then only the Initial Evaluation Fee will be deducted from your initial Quarterly Medical Service Fee, which would leave a balance of $250.00 for your first 3 months of therapy.
Once we have received all of these documents, our office will create a new file for you and begin preparing your case for your Insurance Coverage Review. It is imperative that this step is completed before you have your blood work drawn (step 2), as we must know who you are when the blood work results arrive from the laboratory!
For patients who wish to pursue authorization for Human Growth Hormone (HGH), an additional test is required for approval by insurance companies. This test is considerably more involved then your preliminary laboratory testing, and requires the patient to visit our office in Livonia, MI, for two days of blood draws and a physical examination.
Growth Hormone Stimulation Tests are done by appointment only, and spaces are limited. If you wish to be tested to see if you are a candidate for Growth Hormone replacement therapy, select the optional “Growth Hormone Evaluation Fee” on the included credit card agreement. Our office will contact you to schedule your Stimulation Tests, or will place you on a will call list for future appointments. You will then receive an email as soon as new dates are available, and can call to schedule your testing dates. Typically, we have at least one weekend slot every month for the convenience of work schedules and out of state patients.
Please note that completion of a growth hormone stimulation test is not a guarantee that your insurance company will cover the therapy, but it is a requirement for authorization. If you want your insurance to pay for your growth hormone therapy, then you must complete and pass this test!
Our first panel is by far our most extensive, and checks not only your hormonal levels, but your glucose levels, cholesterol, cancer markers, prostrate levels (for male patients), and a host of other physiologic factors. Please print out the attached prescription and find a diagnostic lab local to you. Your results will be automatically forwarded on to our office.
Instructions for the laboratory testing are included with the attached prescriptions. Please make certain to follow them in entirety. Once your blood has been drawn, the lab will automatically forward the results to our office, which typically takes two to three weeks.
Please be advised that RenAMI will not be held responsible for any fees accrued by the patient from the laboratory, which varies depending on your insurance coverage. See the attached blood work prescription for more details on this, as well as information on paying for your lab work out of pocket.
After your blood work results have been delivered to us, our staff will evaluate your levels to see if you qualify for entrance into our program. We will then contact you with the results of our preliminary review, and whether you qualify for admittance. If you are still interested in continuing, our staff will arrange an Initial Consultation with Dr. Patino. The Doctor will discuss your results, the program requirements and maintenance, and the potential benefits and risks of hormone therapy for your particular physiologic state.
It takes approximately one to three weeks from the receipt of your lab work for a patient to be scheduled for an appointment with Dr. Patino, on average.
If you do not wish to run your medications through your insurance company, and would prefer to pay out of pocket for them, then we can skip Steps 4 & 5 and move directly to “6: Billing Information and Medical Services Agreement”. This cuts a substantial amount of waiting time out of our workflow, and would allow you to begin therapy within a week or so.
Please note that hormone therapy can be extremely expensive, especially if you wish to pursue HGH therapy as well. For approximate out of pocket costs for hormone therapy, please contact your Health Consultant and ask for a cash price list. Please note that the following prices are subject to change, but will give you a rough idea of what to expect. Below are some sample prices (as of 1/1/8) from an affiliated pharmacy:
? Omnitrope Growth Hormone (5.8 mg vial) - $200 each vial
? Testosterone Cypionate (200 mg), 10 mL vial - $79
? Nandrolone Decanoate (200 mg), 10 mL vial - $137
? RenaDEX (Gonadotropin & Estrogen Blocker/Antagonist) - $160
? RenaDEX ES (double strength variation of RenaDEX) - $320
Of course, all of these medications require that you have been approved by the Doctor for their use in your treatment. RenAMI is not a pharmacy, and we do not provide medications on demand, but rather as needed as part of the patient’s overall therapy program.
(You may skip this step if you are paying cash for your medications.)
At this stage, we will contact your insurance company and attempt to receive a Prior-Authorization for the various medications prescribed by Dr. Patino for your personal regiment. This process is integral to our system, as an approved medication will cost you only your insurance co-pays (minus any applicable deductibles from your insurance policy). Compare that to the cost of paying for such a therapy program out of pocket, with an average cost of $250 to $2500 a month or more!
Prior-Authorizations are a very complicated subject, with a life cycle of partial rejections, appeals, delays, and more. Generally, your insurance companies will have established protocols set that will send you a letter when you have reached a certain point in the process. Please ignore these letters, as it is customary for your insurance to deny coverage until we have completely presented our case for its medical necessity. We will inform you if your coverage has been completely denied once we have exhausted all other avenues.
Generally, this stage will take two to three weeks. On rare occasions we will find a patient with such wonderful coverage that our medication requests are approved within a few days, but this is an exception to the norm. We understand that our patients are very interested in the progress of this phase, but please be patient, as we have no control over the speed with which your insurance company operates.
HGH is a very expensive medication, and receives excessive scrutiny from insurance companies regarding all claims. HGH approvals take at least two months, and if thrown into appeals can take substantially longer! Please be patient during this process. If you have completed your Growth Hormone Stimulation test (and received a passing result), then the only thing you can do during this phase of your insurance review is wait.
(You may skip this step if you are paying cash for your medications.)
Eventually we will receive a final ruling from your insurance company for each of the meds prescribed by Dr. Patino.
? Approved – Full Coverage
? Approved – Partial Coverage
? Denied
A staff member from RenAMI will contact then contact you to discuss each result and what that means for you. They will also provide you with pharmacy pricing for patients who wish to purchase Denied medications “out of pocket”.
If you are happy with the results of your insurance coverage, or are willing to pay out of pocket for any medications not covered by your insurance, then we can move on to gathering your billing information.
You will be emailed a Medical Services Agreement, with instructions on how to complete the form and fax it back to our office. Once we have received your signed agreement, we will charge your card $500.00 for our medical services (with deductions for your initial payment for your Initial Evaluation Fee and Growth Hormone Evaluation Fee, if applicable) on your first three months of therapy. We will only charge your card after you have given your signed consent to begin therapy, so you will be able to prepare your finances accordingly. After your initial payment, we will bill your card on the first of the month, every three months, while you continue with our therapy.
Once your initial medical service fees have been processed, we will gather your pharmacy information and send out your first batch of medications. Some insurance companies will mandate a specific pharmacy for certain prescribed medications, but if a choice is provided we have established relationships with mail order retail pharmacies that can deliver your medications directly to your door!
If your insurance policy has mandated a specific pharmacy for mail order medications, then please note that this can greatly increase how long it will take to receive your medications. Insurance Pharmacies (Medco, Caremark, Drams, Option Care, and other similar organizations) will generally take about three weeks to process an order. Retail mail order pharmacies generally only take a few days.
The pharmacy will make arrangements for payment of any costs not paid by your insurance coverage. RenAMI has no control over pharmacy pricing, but has worked to develop discounted costs for your benefit. If you have questions regarding a pharmacy bill, please contact the pharmacy directly, as RenAMI has no access to those records.
After receiving your first batch of hormone medications, please call RenAMI and ask our receptionist to schedule a Medication Tutorial with a Health Consultant. Our staff will walk you through the administration and care of the various medications you have been prescribed. We will send you a detailed Medication Manual, with step by step instructions on the various injections and medications you have been prescribed, so that you may refer to it in the future.
Generally, this process only takes a few days.
That’s it! You have now officially started RenAMI’s therapy.
The following workflow shows what to expect from RenAMI for the continued maintenance of your program.
As a new patient, the world of Hormone Modulation Therapy can be intimidating. More then a few of our patients ask themselves why in the world they are poking themselves with a needle! Our staff at RenAMI is available to answer any questions you might have during those first initial weeks of therapy. Feel free to call us at 1 (800) 718-7264 Option #2 for new patient questions, Monday through Friday from 10am to 4pm, EST.
However, beyond getting used to your new medication regiment, it is also during this first cycle that a small percentage of our patients begin to experience some of the minor side effects associated with Hormone Modulation Therapy. We recognize the concern this can cause to a patient experiencing these issues, but rest assured that such side effects can be treated by adjusting your doses until we find the exact mix your individual physiology tolerates.
Sample side effects include: water retention, nipple tenderness, swollen hands/feet, numb extremities, carpal tunnel syndrome, tennis elbow, tendonitis, acne, and hair loss, depending on your individual medication regiment. If you find yourself experiencing any of these side effects, please call the office at (800) 718-7264 so that we can adjust your medication regiment accordingly. Please do not worry, all of the side effects associated with our therapy can be alleviated through clinical control.
If dosage adjustments are required for your therapy, a RenAMI staff member will contact your pharmacy and submit the necessary changes to your regiment. Generally, dosage changes occur when new refills are requested, either on a monthly or quarterly basis (as determined by your insurance), but individual situations may require a more expedient change.
Once you have started taking your medications, our medical staff will require blood panels approximately every two months to evaluate your body's changes and adapt your prescriptions accordingly. You will receive an email with instructions for your follow up blood work. Follow the instructions listed on the email to have your blood work drawn at a local laboratory. The results will be sent to our office, and generally take about 2 weeks.
Once your levels have been stabilized without the appearance of any applicable side effects, we will increase the period to every three to six months. This step is only taken once we have established a clear protocol for your individual therapy, and you have proven through multiple blood panels that your levels are stable. We call this state “In the Zone”, and RenAMI will inform you once your therapy has reached this level. Generally, it takes several follow up consultations to find a patient’s “Zone”.
After our staff has received your follow up blood work, we will contact you to schedule a new consultation. Here the Doctor or a staff member will go over your progress, taking into account any possible side effects/injuries/issues, and make necessary alterations to your medication regiment.
Occasionally, new medications or revised strengths on existing prescriptions will require a new authorization from your insurance company. This process will delay the application of your new medications while your insurance company is processing the new claim and completing any applicable clinical reviews. Unfortunately, we have no control over this step and can only wait for your insurance company to finish their process before submitting your new/revised medication order.
Additionally, some medications are only approved for a certain term, and require reauthorization every 6 months to a year (on average). We do our best to complete these re-authorizations before the initial coverage expires, thus eliminating any break in your medication coverage, but we are at the mercy of your insurance company for these matters, and can not guarantee their expediency in processing your claims. Generally, however, these matters are completed behind the scenes with almost no impact on a patient’s therapy regiment.
If necessary, our staff will contact your respective pharmacies and submit revised prescriptions for any changes made to your regiment during your consultations. Please be aware that insurance based pharmacies (Medco, Caremark, Option Care, etc.) have a considerable lag time for updating prescriptions, and it could be weeks to a month before the new prescriptions are available. Retail and retail mail order pharmacies will generally have the new prescriptions available within a week.
Though this step does not exactly follow in direct order, RenAMI will bill your credit card for your quarterly or biannual medical service fees, as stated in your individual credit card agreement. Basically, you’ll be paying your fees to us every 3 or 6 months.
Repeat steps 2 - 6
That’s it! Basically, we will repeat steps 2 – 6 forever,
unless you elect to stop your therapy program
Should you elect to cancel your participation in the RenAMI program for any reason, then the patient will be required to provide RenAMI with written notification 30 days prior to the desired date of termination. Upon notification, RenAMI will cancel all future pharmacy prescriptions and lab panels. RenAMI will also discontinue to charge the patient for professional fees, effective the date of termination. There are no refunds for professional fees.
To cancel your program, simply call RenAMI and inform the receptionist of your desire to discontinue your therapy. They will send you an email with further instructions and your Patient Exit Agreement.
New Patient Timeline
Step Details Est. Time
1 Patient Medical History & Consent 1 week
2 Initial Lab Work 3 weeks
3 Initial Consultation 2 weeks
4 Insurance Pre-Authorization Process 1 – 2 months +
5 Insurance Coverage and Pharmacy Information 3 days
6 Billing Information and Credit Card Agreement 3 days
7 Medication Order 1 - 3 weeks
8 Medication Tutorial/New Patient Orientation 3 days
Each individual’s case will be slightly different, as a host of factors weight into the total wait time. Insurance company, laboratory, pharmacy, and patient response times all contribute to the end result, but generally you should expect the entire process to take about 2 – 3 months. The patient’s best bet for “speeding” up the process is to make certain that they have completely filled out their Patient Admission Forms and faxed them (along with their respective insurance card(s), prescription card(s), and driver’s license) to our office as soon as possible. Furthermore, patients should try and visit their local laboratory for their Initial Blood Work at the earliest opportunity, as RenAMI will have to wait on their results before we can schedule the patient’s Initial Consultation.
These estimates make an assumption that the patient is planning to wait on the completion of RenAMI’s insurance coverage review for their prescribed medications. If the patient wishes to omit their insurance review, and pay for their medications directly, then the timeline can be speeded up considerably, usually by at least half!
Estimated Time to Start Therapy
WITH insurance coverage for medications 2 - 3 months
WITHOUT insurance coverage 1 - 1.5 months
